An updated BC guideline from the Guidelines and Protocols Advisory Committee (GPAC), Asthma in Adults, provides recommendations for recognizing, diagnosing, and managing asthma in adults who are 19 years of age or older presenting in a primary care setting. The guideline is available to physicians across British Columbia via www.BCGuidelines.ca and includes a new action plan and flow sheet.
• 30% of asthma patients are mis-diagnosed; send all patients for spirometry, where available, to confirm the diagnosis of asthma.
• Document the history of respiratory symptoms and objective evidence of airflow obstruction (i.e., spirometry) in all patients suspected of or with an asthma diagnosis, even in cases where the diagnosis seems certain.
• Do not prescribe asthma medications in cases of low clinical urgency and where the patient has no documented objective evidence to support an asthma diagnosis.
• As many as 90% of asthma patients use their inhalers incorrectly; regularly review a patient’s inhaler technique, especially when there is a poor or nonresponse to treatment.
• To improve inhaler technique, especially in those with poor coordination, prescribe all patients a spacer when taking their metred dose inhalers (MDI).
• To optimize self-management, consider sending all patients to an asthma education centre, where available.
• Complete a written asthma action plan with all patients and reassess this plan with the patient on a regular basis, especially after an exacerbation.